39 96
Review
–
Andrology
The
Link
Between
Cigarette
Smoking
and
Erectile Dysfunction:
A
Systematic Review
Paolo
Verze
a , * ,Markus Margreiter
b ,Katherine
Esposito
c ,Piero Montorsi
d ,John Mulhall
ea
Department
of
Urology,
University
Federico
II
of
Naples,
Naples,
Italy;
b
Department
of
Urology, Medical
University
Vienna,
General
Hospital,
Vienna,
Austria;
c
Department
of
Geriatrics
and Metabolic
Diseases,
Second
University
of
Naples,
Naples,
Italy;
d
Department
of
Clinical
Sciences
and
Community
Health, University
of Milan,
Centro
Cardiologico Monzino,
IRCCS, Milan,
Italy;
e
Division
of Urology,
Sexual
and
Reproductive Medicine
Program, Memorial
Sloan-Kettering
Cancer
Center, New
York, NY, USA
1.
Introduction
Erectile
dysfunction
(ED)
is
defined
as
the
recurrent
or
consistent
inability
to
obtain
and/or
maintain
a
penile
erection
sufficient
for
satisfactory
sexual
performance
[1].
The
incidence
of
ED
increases
with
age,
reaching
20–40%
in men aged 60–69 yr and 50–100%
in men
in
their
70s and 80s, depending on the heterogeneity of ED definition
in different
studies
[2]. Smoking, one of
the world’s greatest
public
health
problems,
is
also
postulated
to
be
related
to
an
increased
risk
of
ED
in
some
epidemiological
studies.
Although a clear causal relationship exists between cigarette
E U R O P E A N U R O L O G Y F O C U S 1 ( 2 0 1 5 ) 3 9 – 4 6ava il abl e
at
www.sc iencedirect.comjourna l
homepage:
www.europeanurology.comArticle
info
Article
history:
Accepted
January
15,
2015
Associate
Editor:
Shahrokh
Shariat
Keywords:
Smoking
Erectile
dysfunction
Cardiovascular
risk
Nicotine
Impotence
Abstract
Context:
Cigarette
smoking
is an established
risk
factor
for erectile dysfunction
(ED). To
what
extent
smoking
affects
erectile
function,
however,
remains
debated.
Objective:
To
integrate
the
available
evidence
regarding
the
impact
of
smoking
status
and
smoking
exposure
on
prevalence,
severity,
and
progression
in
patients with
ED.
Evidence
acquisition:
A
systematic
search
of
the
literature was
conducted
using
the
Medline, Embase, and Scopus databases
limited
to articles published
in English between
January
1998
and
October
2014.
We
selected
13
articles
according
to
predefined
inclusion
criteria
and
the
Preferred
Reporting
Items
for
Systematic
Reviews
and
Meta-analysis.
Evidence
synthesis:
Most of
the
studies demonstrated
an association between
smoking
and ED. Evidence was also
found supporting the beneficial effect of smoking cessation on
the
restoration of
erectile
function. We noted marked heterogeneity
in patient popula-
tions and smoking categorizations across studies, precluding conduct of a meta-analysis.
Considerable evidence exists
to
support
the hypothesis/theory
that
smoking-related ED
is mainly associated with endothelial
impairment,
reduction
in nitric oxide availability,
and
imbalance
between
oxidative
and
antioxidative
reactions
increasing
oxidative
stress.
Passive
secondhand
cigarette
smoking,
especially with
a
long-term
exposure,
can
also
have
a
negative
impact
on
erectile
function.
Conclusions:
Smoking
is
strongly
associated with ED. Endothelial dysfunction
together
with
increased
oxidative
stress
represent
major
pathophysiologic
mechanisms,
and
smoking
cessation may mitigate
this
effect.
Patient summary:
Current smoking
is significantly associated with erectile dysfunction,
and
smoking
cessation
has
a
beneficial
effect
on
the
restoration
of
erectile
function.
#
2015 European Association of Urology. Published by Elsevier B.V. All
rights
reserved.
* Corresponding
author. Department
of Urology, University
Federico
II
of Naples, Naples,
Italy.
Tel.
+39
081
746
2520;
Fax:
+39
081
7464311.
address:
pverze@gmail.com(P. Verze).
http://dx.doi.org/10.1016/j.euf.2015.01.0032405-4569/
#
2015
European
Association
of Urology.
Published
by
Elsevier
B.V.
All
rights
reserved.